Platelet rich plasma, or PRP, moved from locker rooms and orthopedic conferences into everyday clinics over the past decade. At its best, it is not magic and not hype. It is a methodical way to deliver a concentrated dose of your own platelets and growth factors to a specific tissue that needs help. For joints and tendons in the elbow, shoulder, and hip, that targeted approach matters. These areas often fail to heal because blood supply is limited and mechanical stress is relentless. Using a platelet rich plasma injection to tip the balance back toward repair can make the difference between months of nagging pain and a return to normal movement.
I have used PRP therapy for patients who type for a living and for those who swing hammers, as well as competitive swimmers, pitchers, and weekend cyclists. The common thread is persistent pain that flares with familiar motions. When done with careful diagnosis, a consistent prp procedure, and realistic expectations, platelet rich plasma therapy can help people avoid surgery, reduce pain medication, and get back to work or sport sooner.
What PRP actually is, and what it is not
PRP is a portion of your blood with more platelets than usual. In the lab we typically aim for two to six times baseline concentration. That concentrate contains platelets, a small number of white cells depending on the system used, and plasma proteins such as fibrinogen. The appeal of platelet rich plasma treatment is straightforward. Platelets release growth factors like PDGF, TGF beta, and VEGF that signal cells to proliferate, lay down collagen, and form new blood vessels. In orthopedic applications, we are trying to nudge tendon, ligament, or joint lining cells to restart stalled healing.
It is not a stem cell product. It will not regrow a pristine cartilage surface in an advanced arthritic joint. It does not remove bone spurs or correct structural problems such as significant tears with retraction. In my experience, PRP regenerative therapy works best when the tissue has an intact scaffold but low grade degeneration, micro tearing, or chronic inflammation. That describes a surprising number of elbow, shoulder, and hip problems.
Clinics use different kits and centrifuges, so one person’s prp plasma therapy is not identical to another’s. Some protocols favor leukocyte rich PRP for tendon problems, others prefer leukocyte poor for intra articular injections to reduce post injection inflammation. The details matter and should be discussed before the prp injection procedure.
The prp procedure, from blood draw to ultrasound guidance
On a typical day, the visit takes 45 to 90 minutes. We draw a small volume of blood, usually 15 to 60 milliliters depending on the target and the system. The sample goes into a centrifuge to separate red cells, buffy coat, and plasma, then we extract the platelet rich fraction. Quality control is not an afterthought. A good prp clinic tracks concentration, volume, and uses sterile technique with closed systems when possible. Some settings use a small activator such as calcium chloride to start the clotting cascade just as the platelet rich plasma injection enters the target tissue, which can improve retention in tendons. Activation is not used for every indication.
Guidance is critical. Blind injections into deep joints or precise tendon insertions are guesswork. Ultrasound guidance lets me see the needle, confirm the tissue plane, and avoid neurovascular structures. In the shoulder, for example, the subacromial bursa and rotator cuff insertion can be targeted separately. In the hip, the joint capsule lies deep under thick soft tissue, and the trochanteric bursa sits lateral to the gluteal tendon insertions. In the elbow, the common extensor tendon complex at the lateral epicondyle is a small, specific target. Good placement is the difference between a prp orthopedic injection and a placebo.
Patients often ask whether the prp healing injection hurts. There is some sting, usually brief. Local anesthetic can be used on the skin and needle track, but I avoid mixing anesthetic with the PRP itself for tendon work, since lidocaine and bupivacaine can be toxic to tenocytes in high concentration. For intra articular prp joint therapy, a small amount of anesthetic at the capsule can be reasonable. Post injection soreness is common for 24 to 72 hours, and I advise against anti inflammatory drugs during that period because they can blunt platelet activation. Use acetaminophen or a brief course of ice if needed.
Elbow pain: from keyboard tendinitis to stubborn tennis elbow
The elbow lends itself well to prp tendon treatment. Lateral epicondylosis, better known as tennis elbow, is rarely about inflammation. It is a degenerative change in the common extensor tendon, often the extensor carpi radialis brevis. Microscopic tears, disorganized collagen, and small nerve ingrowth contribute to pain with gripping and wrist extension.
For patients who have done the basics, from eccentric strengthening to ergonomic changes, and still feel that sharp ache lifting a pan or shaking hands, PRP is a sensible next step. Randomized trials and meta analyses show a moderate benefit of prp injection therapy compared with corticosteroid at 3 to 12 months. Steroids offer quick relief but a high relapse rate. PRP tends to build slowly over weeks, with more durable outcomes. In clinic, my success rate for chronic lateral epicondylosis is in the 70 to 80 percent range, defined as meaningful pain reduction and return to function within three months, with one to two injections.
Medial epicondylosis, golfer’s elbow, can also respond, though results vary more. Partial tears of the distal biceps tendon are a different conversation. prp injection FL I avoid injecting into the tendon substance where the risk of rupture exists. If the tear is minor and symptoms are primarily tendinopathic, PRP around the tendon sheath may help, but clear imaging and a conservative plan are essential.
Cubital tunnel symptoms such as numbness in the ring and small fingers are nerve problems rather than tendon degeneration. PRP is not a fix for nerve entrapment, and trying to treat neuropathy with platelet therapy in that region can miss the diagnosis.
Shoulder pain: rotator cuff disease and frozen shoulder
The shoulder is a busy joint with multiple pain generators. When someone says shoulder pain, I break it down. Is it rotator cuff tendinopathy, partial thickness tearing, subacromial bursitis, biceps tendon tendinosis, or adhesive capsulitis? PRP can be useful, but only when the target matches the therapy.
Rotator cuff tendinopathy without a full thickness tear is a good fit. Injecting PRP at the critical zone of the supraspinatus tendon under ultrasound can stimulate remodeling. I combine it with a precise subacromial bursa injection if the bursa is inflamed. Over 6 to 12 weeks, patients usually report better sleep and improved abduction strength. For partial thickness tears, PRP can help small articular sided defects, although thicker tears that catch and grind may still need arthroscopic debridement or repair. PRP is an adjunct, not a replacement, for some structural problems.
Biceps tendon disease in the groove is a nuanced case. A small volume prp orthopedic therapy around the tendon sheath can calm tenosynovitis, but I avoid injecting into the tendon fibers. For labral tears, PRP has limited evidence. I do not recommend intra articular platelet therapy as a primary treatment for labral instability.
Adhesive capsulitis, or frozen shoulder, behaves like a capsular contracture with inflammation. Steroid injections remain more predictable in the early inflammatory phase for pain control. I have used PRP inside the glenohumeral joint for later phases with mixed results. If capsular tightness is the main driver, aggressive stretching, home pulleys, and occasional hydrodilatation tend to outperform biologics. Knowing when PRP helps and when it will disappoint is part of the judgment call.
Hip pain: two problems hiding behind a single word
Hip complaints often split into two distinct categories. One is intra articular osteoarthritis with aching in the groin, stiffness after sitting, and pain climbing stairs. The other is lateral hip pain, historically called trochanteric bursitis, now better understood as gluteus medius and minimus tendinopathy with or without a true bursal component. PRP can help both, but the approach differs.
For greater trochanteric pain syndrome, PRP targeted to the gluteal tendon insertions is often more effective than simply filling the bursa. Patients who struggle to lie on their side, climb stairs, or stand on one leg notice gradual improvement over 6 to 10 weeks. The evidence base here is growing. In my caseload, PRP shows a better midterm response than repeated corticosteroid injections, which can briefly quiet things then rebound.
In hip osteoarthritis, a platelet rich plasma injection into the joint can reduce pain and stiffness for several months. Studies comparing prp medical treatment to hyaluronic acid often show similar or slightly better outcomes for PRP in mild to moderate arthritis. The benefit is dose dependent. Some protocols use a series of two to three injections spaced two to four weeks apart, aiming for a cumulative effect. This is not joint regeneration. It is symptom control and functional improvement while delaying surgery, which for many patients is a worthwhile goal.
I avoid PRP in the presence of advanced bone on bone changes for patients who expect lasting relief. It is not fair to promise what the biology cannot deliver. For labral tears with femoroacetabular impingement, correcting bony conflict and repairing the labrum is the main solution. PRP has a role post operatively as an adjunct in some centers, but not as a standalone fix for impingement.
How PRP fits with therapy, mechanics, and time
No injection overcomes poor mechanics or deconditioned tissue. For elbow, shoulder, and hip, I map out a rehab plan that respects biology. The first week focuses on relative rest, gentle range of motion, and pain modulation without NSAIDs. By week two or three, we introduce isometrics, then progress to eccentric and concentric loading in a graded way. The cadence matters. Too fast invites flare ups; too slow leaves the tissue under stimulated.
In the elbow, I like eccentric wrist extension with a small dumbbell, forearm pronation supination control, and grip strength work once pain allows. For shoulder, the program ramps from scapular setting and isometrics to rotator cuff strengthening in low arc positions, then overhead progressions as tolerated. The hip plan builds from side lying abduction isometrics to standing lateral band walks, step downs, and single leg stance stability. Gait mechanics and pelvic control affect lateral hip symptoms as much as local tendon work.
Load management extends to daily habits. Swimmers modify stroke volume and avoid painful catch positions for a spell. Tennis players may change grip size and string tension. Desk workers adjust setup to keep the wrist neutral and reduce reach. Small changes add up, and they extend the benefits of prp pain therapy beyond the injection window.
Expectations, timelines, and who benefits most
The most common error is expecting surgical speed from a biologic process. Typical timelines vary by site. The elbow often responds within 4 to 8 weeks. The shoulder, especially rotator cuff tendinopathy, takes 6 to 12 weeks. Lateral hip pain can lag, with steady gains appearing between 6 and 10 weeks. For mild to moderate hip arthritis, the best window is often 2 prp specialists in Florida to 6 months after the series, with a gradual fade thereafter. Repeat treatments are reasonable if the first course delivered clear benefit.
Ideal candidates are those with a well defined diagnosis, imaging that shows tendinopathy or partial thickness tearing rather than a complete rupture, and willingness to follow a rehab plan. People hoping to avoid or delay surgery, and those who cannot tolerate corticosteroids, often consider PRP. Patients on strong blood thinners or with platelet disorders may not be good candidates. Active infection, fever, or a skin lesion at the injection site are hard stops.
Costs vary widely by region and clinic. Because platelet therapy is autologous and procedural, insurance coverage remains inconsistent. I counsel patients to expect out of pocket costs that may range from a few hundred to a couple thousand dollars per session. Results are not guaranteed, which makes a clear discussion about likelihood of success essential. When a patient asks me whether PRP is worth it, I compare it to the realistic alternatives: more physical therapy, corticosteroid with its downsides, hyaluronic acid for certain joints, or surgical options. That comparison sharpens the decision.
Evidence without exaggeration
The literature around PRP is large, mixed, and sometimes confusing. Different studies use different preparations, concentrations, and injection protocols. That variability explains why meta analyses can reach conflicting conclusions. When you strip away the noise, several patterns are consistent.
For chronic lateral epicondylosis, platelet rich plasma therapy shows better long term outcomes than corticosteroid and often outperforms saline or dry needling. For rotator cuff tendinopathy and small partial tears, PRP can reduce pain and improve function compared to exercise alone, though not every trial finds a significant difference. For greater trochanteric pain syndrome, PRP appears superior to corticosteroid at six months in several pragmatic studies. For mild to moderate knee osteoarthritis, PRP has been studied more extensively and generally shows benefit over hyaluronic acid or saline. That knee data is relevant when counseling hip arthritis patients, though hips are not knees.
It is also important to note where PRP underperforms. It does not reliably improve outcomes in advanced osteoarthritis. It does not close full thickness rotator cuff tears. It is not a substitute for addressing mechanical impingement in the hip or shoulder. Using PRP outside its strengths either wastes time or undermines confidence in a therapy that can help when used well.
The role of imaging guidance and technique
Ultrasound guidance increases accuracy, reduces complications, and lets me tailor the injection to the actual pathology. On ultrasound, degenerative tendons look thickened and hypoechoic with loss of fibrillar pattern, and sometimes neovessels appear. Injections can be peppered across the diseased zone after gentle fenestration, which provides micro bleeding and channels for the PRP. For intra articular work, real time guidance ensures the platelet therapy injection enters the joint space rather than periarticular tissues.
Sterility is not negotiable. Chlorhexidine prep, sterile gloves, and a clean field are baseline. For deeper joints, a sterile probe cover and gel are used. The PRP itself should be prepared in a closed or semi closed system to limit contamination. These are mundane details until a complication occurs. I share this because patients sometimes shop on price alone. Technique, focus, and hygiene are worth paying for.
What about combination therapies?
Some clinics pair PRP with needling procedures, hyaluronic acid, or even low level laser in the same session. I remain conservative. Dry needling or fenestration is part of most tendon protocols already, since it primes the area. Combining PRP with hyaluronic acid in a single intra articular injection is debated. There are small studies suggesting synergy in knees, but data for hips and shoulders is sparse. Stacking treatments can also make it harder to know what worked. I prefer a clean design, measure the effect, then iterate if needed.
For skin and aesthetic uses, prp facial, prp microneedling, and prp with microneedling for acne scars, fine lines, and under eyes are popular, but they live in a different lane. Those procedures leverage platelet factors for prp skin rejuvenation, prp for wrinkles, and prp for anti aging rather than for tendon or joint healing. The overlap is biological, yet the goals and techniques differ. Patients sometimes ask whether doing prp for face or prp for hair growth on the same day as a joint treatment makes sense. I separate sessions to avoid excessive blood draw volume and to watch for local reactions. There is no additive benefit to doing everything at once.
Aftercare, setbacks, and when to call
After most prp injections, I advise 48 hours of relative rest on the injected area, then a gentle return to baseline activities as pain allows. Avoid heavy lifting or explosive motions for a couple of weeks for tendons, and avoid long pounding runs for hips immediately after an intra articular injection. Warm dull soreness is normal. Red, hot swelling with fever is not. If bruising appears, it typically fades within a week. If numbness or tingling occurs beyond the expected window of local anesthetic, we reassess to rule out neuritis.
A small percentage of patients feel worse before they feel better. If that flare lasts more than a week or two, we slow the rehab or adjust loading. The goal is stimulus, not provocation. Communication in the first month makes a difference.
A practical snapshot: who might consider PRP now
- A 42 year old graphic designer with 9 months of lateral elbow pain, failed bracing and therapy, MRI showing tendinopathy but no tear, who wants to avoid steroid relapse. A 55 year old tennis player with night pain from rotator cuff tendinopathy, intact cuff on ultrasound, motivated for a 12 week strengthening plan alongside a targeted PRP injection. A 63 year old walker with lateral hip pain, tender over the greater trochanter, ultrasound showing gluteus medius tendinopathy, who has had two short lived steroid injections and wants a more durable solution. A 58 year old with mild hip osteoarthritis on X ray, morning stiffness, limited internal rotation, considering a series of intra articular PRP treatments to delay arthroplasty. A 35 year old overhead athlete with biceps tendon tenosynovitis, responsive to rest but recurring, seeking a sheath targeted platelet rich plasma treatment and a mechanics tune up.
Each of these cases benefits from a detailed evaluation, a clear prp medical therapy plan, and a matched rehab pathway. Age alone does not decide the outcome. Tissue quality, diagnosis accuracy, and patient participation do.
Where PRP sits among other options
Corticosteroid injections remain useful for acute inflammatory flares, especially in the subacromial bursa or an acutely irritated trochanteric bursa. The tradeoff is transient relief and potential tendon weakening with repeated doses. Hyaluronic acid has a role inside arthritic knees and sometimes hips, easing glide and reducing pain for a subset of patients. Prolotherapy, dextrose injection around ligaments and tendons, can help certain ligamentous pains but is less studied. Surgical options are better for clear mechanical disruptions: rotator cuff tears with retraction, significant labral pathology with instability, or end stage osteoarthritis.
PRP sits between conservative care and surgery as a biologic nudge. It is a prp non surgical treatment with a safety profile that is generally favorable, since it is your own autologous product. Side effects include temporary pain, bruising, and rare infection. Allergic reactions are highly unlikely because there is no foreign protein in prp autologous therapy.
A word on broader PRP uses and why focus matters
You have likely seen PRP discussed for hair and skin. In the right hands, prp hair treatment can reduce shedding and thicken miniaturized hairs for men and women with early androgenetic alopecia. Protocols usually include a series of monthly sessions followed by maintenance. For facial rejuvenation, prp skin treatment with microneedling can improve texture, fine lines, and acne scars. The prp vampire facial label makes for catchy marketing, but the mechanism is the same: platelet derived signals telling skin to heal. These prp beauty treatment and prp cosmetic therapy applications are separate from prp joint therapy, yet they illustrate the broader point. Location and technique dictate results.
For someone reading about prp for hair loss and prp for face in the same breath as prp for joints, the key is selecting a clinic that treats your problem routinely, not as an afterthought. A practice that does hundreds of prp orthopedic injections a year is better placed to help your elbow or hip than a spa focused on prp facial services. The opposite is true for under eye work, fine lines, or acne scars.
The bottom line for elbows, shoulders, and hips
PRP is not a cure all, but it is a practical tool when the diagnosis is right and the expectations are aligned. It leverages your own biology to restart healing in tissues that are undernourished and overworked. For elbow tendinopathy that has outlasted bracing and exercise, for rotator cuff irritation that keeps you awake, and for lateral hip pain that scoffs at steroid shots, a platelet rich plasma treatment is worth a serious look.
If you pursue it, ask specific questions. What concentration do you use for this indication? Will you use ultrasound guidance? How many injections are typical, and over what timeframe? What is your rehab protocol? How will we measure progress? The right answers do not guarantee success, but they stack the odds in your favor.
PRP belongs in the same conversation as careful diagnosis, smart loading, and the passage of time. Put those together, and the path back to pain free motion becomes realistic.